Humana engages with individuals dually eligible for Medicare and Medicaid programs through Medicare Advantage Special Needs Plans (SNPs) as well as through innovative federal/state demonstration programs. Humana is participating in joint Centers for Medicare & Medicaid Services (CMS)/state Medicaid department demonstration projects in Illinois and Virginia to address the quality and financial integration issues around the care of people who are dually eligible for Medicare and Medicaid. “Dual eligible” individuals, as these seniors and younger people with disabilities are called, typically are some of the most vulnerable people in the healthcare system.
As a group, dual eligible individuals account for a disproportionate share of spending in both programs. People who qualify for full dual benefits are estimated to make up 13% of the combined population of Medicare enrollees and aged, blind or disabled Medicaid enrollees, but they account for 34% of those programs’ total spending on those enrollees, according to a 2013 report by the Congressional Budget Office.
Our goal is to improve population health outcomes and help states and the federal government control costs for the vulnerable dual eligible population. The first step is to make using the healthcare system easier. Medicare and Medicaid are two different programs that cover different things, operate under different rules and were never designed to work together. Under the demonstration program, Humana works to integrate the two programs to provide as seamless a level of coverage to our members as possible, giving them one card, one point of contact, one set of benefits, and one care treatment plan. We also take real responsibility for dual eligible members by managing and integrating their care.
Here’s how we accomplish those goals:
Implementation of the dual-eligible demonstrations began in 2014, and the feedback so far has been promising. Through the patient-care worker meetings that occur in order to create individualized plans, relationships are formed and needs are seen and addressed.
To learn about Humana’s policy on dual-eligible people, check out this page.